9704-140 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
„Date �,/Z �191 Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(/ ) I have and will maintain workers' compensation insurance, as required by
Setion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
UNlCAR117 INS CO SI:Stt119614179
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I sh�ld become
subject to the workers' compensation s. provisio�of Section 3700 -of the Labor
Code, I shallr ortwit . comply with thoas�fprovl Ion
Date: Applicant—/ f%�.� rf - • - "�f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. ,
1. Each person upon whose behalf this application is made & each person at/
whose request and for whose benefit work is performed under or pursuant �tt
any permit issued as a result of this applicaton agrees to, & shall, inde(m fyy
& hold harmless the City of La Quinta, its officers, agents and employee,5/
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of`this City to enter upon
the above-mentioned property for inspection purposes.
v4nature (Owner/Agent) ., % �� Date
BUILDING PERMIT PERMIT# CONTROL'#
ij7EI+� ��1� 5 �2•a.
DATE VALUATION LOT TRACT
;5t torS121,;578..it1 102
JOB SITE
ADDRESS 1 47-820VIA TilIESTE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CA1':ADAY &CtaMWANY
C'ANADAY & COMPANY
15707 8X00i 110LWW DR. 91t. 208
15708ROOKHOLLOW DRIVE, SUM 308
SANI'A ANA CA 92705
SANTA ATMA CA 92705
(7i�I175T-Q15I CK4 1485
USE OF PERMIT
SO)
St ll - f�ti1u4f1'C Cst ►tti IJiaT Ij�tCLUf71a bLCst:Ti WtiLLB 012 I'OvL. PLAN
C11L0K F'UE 1 14XIC.10 tit' 7S? b F(. -PR MULTIPLE i`iS(1ANCE OF SAME PLAN.
1itACi' Cvi�1S'i"11Ii: TLOid :,013.00
I'ORC10A T (O 40.11) :ih'
OAN A( -*-J ARP0kT 54 90) 8F
rxi'miAstim c,t yr coir;'t71 mitt1C.•1'tON
121.578.30
i'lhlXMIT FEE S#lliili ARV
C, INS'Mi)( 11CIN 1 F H 101-000-1194M $716!W
P1. AN 0 WCK frl {? tf)i-f3f)t1•�135?-3t3{ 5144.135
&H.C.11ANiCAL FWL 101-1)0{1.421-000 Srib.Stt
tsl.ii('I'XICA1,1-it Ii lot-OW-4204*0 �t�►S4if
PLU{t11ilf+O FHE 101 -OW -419.01K) SI�;S. ►
S% , 4"f ION . R171410 101 -OW -14114M
GRAI ING FF*U I()1 -000»323 -OW S t1.td)
IN0kA.S'1`t(t1(, I'IJ1(1% HiP. 22.5.000-44.1-342 $2,i`.�1.54
ART IN PLMLIC'1'LA"F.4 . Ri-ls , 70I-<Ntit•2'S5-(W S51148
� Y
n ,
SUB-r91,A.I,CON'ElRtIt:' ON AND PLAN
$4,024 J-1
LESS 11RE-PAH) FEE'S
su.(x)
TI A$, 011u NOW
S4,024.44
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWAI ItAgiPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test (424 1p
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) fell
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building j�
Address 417 r✓ I7O V G
Owner
CG vt < G .J <6 j"'P4
Mailing
Address's 70
City Zip Tel.
40, 4 n`,<� C12 70 J 171
Contractor r
C4 h r G, V co i vw
Address
•4
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
-77`1 F'/J—/ Legal Description�r
i
ty IZip ITel. /
State Lic. City
& Classif. Lic. # i Z
Arch., Engr., /�**
Designer ��% �,,�/ � n S S t^,j is.
Address r T760 j y
�y� �ri ��,�►s 212//
City Zi.4 State
r.%-5�, , F2�G�Lig.#
LrICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
FJ1 I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the ownepbuilder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I I I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does -not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I'] I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
Project Description
Sq. Ft. 0/ 3 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
treet Setback from Center Line
Setback from Property Line
FINAL DATE iq INSPECTOR
Issued by: ~r Date Permit
Validated b '�"
Validat yr
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES a
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT, @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
IKITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
1 uM'b SiGmA 1 Umtwr4I I IAL5
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/13/97
No. 15509
Owner Name Canaday & Company
No. 47820
City La Quinta
Tract # 26152
Type of Development
By
Comments
Street Via Trieste
APN # 643-130-061
Jurisdiction La Quinta
Permit #
Log #
Zip 92253' Study Area 123
Lot # 102 'Square Footage 2013
Single Family Residence'
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 2,013 or $ 3,703.92 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By cc/Pacific National Bank/PNB/Canaday & Co. Telephone
Name on the check
Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by ' Pauline Pearson
Signature A, Q OPA1,AAA/V(—
Payment
Received $3,703.92
Check No. 67456
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s) behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant ' Copy - Applicant/Receipt Copy - Accounting
Rtlomc� ,
L;►lis�L;► (�ui�il�► Ai chit •lur�►1 Cnmuitt ca
Date: 97
Re: Lot No: ir/ y8
Address:
Your request for Ipproval of
Has been:
Approved
Subject to:
Denied '
Reason for denial:
a�
air u f Architectural Committee
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 909 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. .For the following:
BUILDING ADDRESS: 47-820 VIA TRIESTE
,Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9704-140
Occupancy Group: R-3 Type of Construction:
Owner of Building: CANADAY AND COMPANY
Building Official
VN Land Use Zone: RL
Address: 17480 EAST 17T" ST. #106
City: TUSTIN, CA 92780
By: STEVE TRAXEL
Date: 06-09-99
POST IN A CONSPICUOUS PLACE